Provider Demographics
NPI:1619251113
Name:NELSON, JAMES PATRICK (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PATRICK
Last Name:NELSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 CENTWAY PARK DR
Mailing Address - Street 2:APT 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8477
Mailing Address - Country:US
Mailing Address - Phone:704-564-5536
Mailing Address - Fax:
Practice Address - Street 1:11240 CENTWAY PARK DR
Practice Address - Street 2:APT 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8477
Practice Address - Country:US
Practice Address - Phone:704-564-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer